Zhang Xue-Mei, Shen Wei-Wei, Song Ling-Jun
Pathology Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2023 Jun 13;13:1183784. doi: 10.3389/fonc.2023.1183784. eCollection 2023.
Lymph node metastasis is one of the most important prognostic factors of gastric cancer. However, the effect of germinal centers in lymph nodes on the prognosis of patients with gastric cancer has not been reported. This study aimed to investigate the contribution of germinal center generation to prognostic parameters and clinicopathological significance in gastric cancer.
We retrospectively reviewed gastric cancer patients who underwent surgery from October 2012 to June 2022. We analyzed 5484 lymph nodes (210 patients) and calculated the lymph node metastasis rate (LNMR) and the proportion of non-metastatic lymph nodes containing three or more germinal centers (NML-GCP).
Using a grading system that incorporated LNMR and NML-GCP. The tumors were classified into three groups based on this system, which was found to be significantly associated with prognosis. The TNM stage and grading system of lymph node status were independent risk factors for overall survival (OS) and disease-free survival (DFS). The 5-year OS rates for patients with advanced gastric cancer were 85.07% (n=50), 58.34% (n=42), and 24.44% (n=21) for Grades 1, 2, and 3, respectively (<0.0001). The 5-year DFS rates were 65.32% (n=58), 40.85% (n=51), and 5.88% (n=34), respectively (<0.0001). Patients with Grade 1 advanced gastric cancer had higher 5-year OS and DFS rates compared to those with Grade 2 or 3 in TNM stage II and III. Furthermore, the 5-year OS and DFS rates differed significantly among patients with different grades of advanced gastric cancer who received chemotherapy (<0.0001).
These findings suggest that the grading system may be valuable for predicting prognosis and guiding clinical management in patients with gastric cancer, and provides good prognostic stratification for OS and DFS in patients with TNM stage II and III.
淋巴结转移是胃癌最重要的预后因素之一。然而，淋巴结生发中心对胃癌患者预后的影响尚未见报道。本研究旨在探讨生发中心形成对胃癌预后参数的贡献及临床病理意义。
我们回顾性分析了2012年10月至2022年6月接受手术的胃癌患者。我们分析了5484个淋巴结（210例患者），并计算了淋巴结转移率（LNMR）和含有三个或更多生发中心的非转移淋巴结比例（NML-GCP）。
采用结合LNMR和NML-GCP的分级系统。根据该系统，肿瘤被分为三组，发现其与预后显著相关。淋巴结状态的TNM分期和分级系统是总生存期（OS）和无病生存期（DFS）的独立危险因素。晚期胃癌患者1级、2级和3级的5年OS率分别为85.07%（n = 50）、58.34%（n = 42）和24.44%（n = 21）（<0.0001）。5年DFS率分别为65.32%（n = 58）、40.85%（n = 51）和5.88%（n = 34）（<0.0001）。在TNM II期和III期，1级晚期胃癌患者的5年OS和DFS率高于2级或3级患者。此外，接受化疗的不同分级晚期胃癌患者的5年OS和DFS率差异显著（<0.0001）。
这些发现表明，该分级系统可能对预测胃癌患者的预后和指导临床管理有价值，并为TNM II期和III期患者的OS和DFS提供良好的预后分层。
